Skip to main content


Log in

Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript



The association of recreational physical activity (RPA) with mortality is well established only for breast and colon cancers and few studies have evaluated relationships for exercising before and after diagnosis, across multiple disease sites. We examined the joint associations of pre- and post- diagnosis RPA with mortality in a cohort of 5,807 patients enrolled in the Data Bank and BioRepository at Roswell Park.


Patients were classified into one of four activity categories (habitually active, increased activity after diagnosis, decreased activity after diagnosis, habitually inactive). Cox proportional hazards models were used to estimate the associations of activity status with mortality.


In comparison to patients who were habitually inactive, habitually active patients experienced a 39% decreased hazard of all-cause mortality (HR = 0.61, 95% CI 0.54–0.69) and a 36% decreased hazard of cancer-specific mortality (HR = 0.64, 95% CI 0.56–0.73). Previously inactive patients who began exercising after diagnosis experienced a 28% decreased hazard of all-cause (HR = 0.72, 95% CI 0.59–0.89) and cancer-specific mortality (HR = 0.72, 95% CI 0.57–0.91) in comparison to patients who remained inactive. Patients engaging in 3–4 sessions/week experienced the greatest survival advantages, but 1–2 sessions/week also yielded significant survival advantages in comparison to inactivity.


Low-to-moderate frequency pre- and post-diagnosis RPA was associated with significantly decreased mortality in patients diagnosed with a variety of malignancies. These observations solidify the clinical and public health importance of the message that some regular activity is better than inactivity, which is particularly encouraging, given that cancer survivors can be overwhelmed by current daily physical activity recommendations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others



Recreational physical activity


Moderate-to-vigorous intensity physical activity


Body mass index


Data Bank and BioRepository


  1. NCI. Cancer Survivors, and Physical Activity: U.S. Department of Health and Human Services; 2018 [updated February 2018; cited 5 March 2018].

  2. Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J et al (2016) The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. British journal of sports medicine 50(6):339–345.

    Article  PubMed  Google Scholar 

  3. Schmid D, Leitzmann MF (2014) Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol 25(7):1293–1311

    Article  CAS  Google Scholar 

  4. Alfano CM, Klesges RC, Murray DM, Bowen DJ, McTiernan A, Vander Weg MW et al (2004) Physical activity in relation to all-site and lung cancer incidence and mortality in current and former smokers. Cancer Epidemiol Biomark Prev 13(12):2233–2241

    Google Scholar 

  5. Arem H, Moore SC, Park Y, Ballard-Barbash R, Hollenbeck A, Leitzmann M et al (2014) Physical activity and cancer-specific mortality in the NIH-AARP Diet and Health Study cohort. Int J Cancer 135(2):423–431

    Article  CAS  Google Scholar 

  6. Hastert TA, Beresford SA, Sheppard L, White E (2014) Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the Vitamins and Lifestyle (VITAL) Study. Cancer Causes Control 25(5):541–542.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kampert JB, Blair SN, Barlow CE, Kohl HW 3rd (1996) Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol 6(5):452–457

    Article  CAS  Google Scholar 

  8. Lee JY, Ryu S, Cheong E, Sung KC (2016) Association of physical activity and inflammation with all-cause, cardiovascular-related, and cancer-related mortality. Mayo Clin Proc 91(12):1706–1716

    Article  Google Scholar 

  9. McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C et al (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomark Prev. 20(6):1089–1097.

    Article  Google Scholar 

  10. O’Donovan G, Lee IM, Hamer M, Stamatakis E (2017) Association of “Weekend Warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Intern Med 177(3):335–342.

    Article  PubMed  Google Scholar 

  11. Parekh N, Lin Y, Craft LL, Vadiveloo M, Lu-Yao GL (2012) Longitudinal associations of leisure-time physical activity and cancer mortality in the Third National Health and Nutrition Examination Survey (1986–2006). J Obesity.

    Article  Google Scholar 

  12. Maldonado G, Greenland S (1993) Simulation study of confounder-selection strategies. Am J Epidemiol 138(11):923–936

    Article  CAS  Google Scholar 

  13. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Controlled Clinical Trials 7(3):177–188

    Article  CAS  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  Google Scholar 

  15. Borch KB, Braaten T, Lund E, Weiderpass E (2015) Physical activity before and after breast cancer diagnosis and survival—the Norwegian women and cancer cohort study. BMC Cancer 15:967.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS (2016) Physical activity and survival after prostate cancer. Eur Urol 70(4):576–585

    Article  Google Scholar 

  17. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD et al (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 97(7):1746–1757

    Article  Google Scholar 

  18. Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML et al (2011) Physical activity and survival in postmenopausal women with breast cancer: results from the women’s health initiative. Cancer Prev Res 4(4):522–529.

    Article  Google Scholar 

  19. Campbell PT, Patel AV, Newton CC, Jacobs EJ, Gapstur SM (2013) Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol 31(7):876–885.

    Article  PubMed  Google Scholar 

  20. Kuiper JG, Phipps AI, Neuhouser ML, Chlebowski RT, Thomson CA, Irwin ML et al (2012) Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer Causes Control 23(12):1939–1948.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA et al (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24(22):3527–3534

    Article  Google Scholar 

  22. Schmid D, Behrens G, Arem H, Hart C, Herr W, Jochem C et al (2018) Pre- and post-diagnosis physical activity, television viewing, and mortality among hematologic cancer survivors. PLoS ONE 13(1):e0192078

    Article  Google Scholar 

  23. Cannioto RA, LaMonte MJ, Kelemen LE, Risch HA, Eng KH, Minlikeeva AN et al (2016) Recreational physical inactivity and mortality in women with invasive epithelial ovarian cancer: evidence from the Ovarian Cancer Association Consortium. Br J Cancer 115(1):95–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Cannioto RA, Moysich KB (2015) Epithelial ovarian cancer and recreational physical activity: a review of the epidemiological literature and implications for exercise prescription. Gynecol Oncol.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moorman PG, Jones LW, Akushevich L, Schildkraut JM (2011) Recreational physical activity and ovarian cancer risk and survival. Ann Epidemiol 21(3):178–187.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhou Y, Chlebowski R, LaMonte MJ, Bea JW, Qi L, Wallace R et al (2014) Body mass index, physical activity, and mortality in women diagnosed with ovarian cancer: results from the Women’s Health Initiative. Gynecol Oncol 133(1):4–10

    Article  Google Scholar 

  27. Liss MA, White M, Natarajan L, Parsons JK (2017) Exercise decreases and smoking increases bladder cancer mortality. Clin Genitourinary Cancer 15(3):391–395.

    Article  Google Scholar 

  28. Wang L, Wang C, Guan S, Cheng Y (2016) Impacts of physically active and under-active on clinical outcomes of esophageal cancer patients undergoing esophagectomy. Am J Cancer Res 6(7):1572–1581

    PubMed  PubMed Central  Google Scholar 

  29. Arem H, Park Y, Pelser C, Ballard-Barbash R, Irwin ML, Hollenbeck A et al (2013) Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients. J Natl Cancer Inst 105(5):342–349.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Arem H, Chlebowski R, Stefanick ML, Anderson G, Wactawski-Wende J, Sims S et al (2013) Body mass index, physical activity, and survival after endometrial cancer diagnosis: results from the Women’s Health Initiative. Gynecol Oncol 128(2):181–186.

    Article  PubMed  Google Scholar 

  31. LaMonte MJ, Buchner DM, Rillamas-Sun E, Di C, Evenson KR, Bellettiere J et al (2017) Accelerometer-measured physical activity and mortality in women aged 63 to 99. J Am Geriatr Soc.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zhong S, Jiang T, Ma T, Zhang X, Tang J, Chen W et al (2014) Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol 29(6):391–404.

    Article  PubMed  Google Scholar 

  33. Li Y, Gu M, Jing F, Cai S, Bao C, Wang J et al (2016) Association between physical activity and all cancer mortality: dose-response meta-analysis of cohort studies. Int J Cancer 138(4):818–832.

    Article  CAS  PubMed  Google Scholar 

  34. Blair SN, Cheng Y, Holder JS (2001) Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc 33(6 Suppl):S379–S399; discussion S419-20

    Article  CAS  Google Scholar 

  35. Janssen I, Jolliffe CJ (2006) Influence of physical activity on mortality in elderly with coronary artery disease. Med Sci Sports Exerc 38(3):418-17

    Article  Google Scholar 

  36. Sundquist K, Qvist J, Sundquist J, Johansson SE (2004) Frequent and occasional physical activity in the elderly: a 12-year follow-up study of mortality. Am J Prev Med. 7(1):22–27.

    Article  Google Scholar 

  37. Berger N (2010) Cancer and energy balance: epidemiology. Springer, New York

    Book  Google Scholar 

  38. McTiernan A (2008) Mechanisms linking physical activity with cancer. Nat Rev Cancer 8(3):205–211.

    Article  CAS  PubMed  Google Scholar 

  39. Byers T (2014) Physical activity and gastric cancer: so what? An epidemiologist’s confession. Cancer Prev Res. 7(1):9–11.

    Article  Google Scholar 

  40. Hildebrand JS, Gapstur SM, Gaudet MM, Campbell PT, Patel AV (2015) Moderate-to-vigorous physical activity and leisure-time sitting in relation to ovarian cancer risk in a large prospective US cohort. Cancer Causes Control.

    Article  PubMed  Google Scholar 

  41. Sanchis-Gomar F, Lucia A, Yvert T, Ruiz-Casado A, Pareja-Galeano H, Santos-Lozano A et al (2015) Physical inactivity and low fitness deserve more attention to alter cancer risk and prognosis. Cancer Prev Res 8(2):105–10.

    Article  Google Scholar 

  42. Pedersen L, Idorn M, Olofsson GH, Lauenborg B, Nookaew I, Hansen RH et al (2016) Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab 23(3):554–62.

    Article  CAS  PubMed  Google Scholar 

  43. Betof AS, Lascola CD, Weitzel D, Landon C, Scarbrough PM, Devi GR et al (2015) Modulation of murine breast tumor vascularity, hypoxia and chemotherapeutic response by exercise. J Natl Cancer Inst 107(5):djv040

    Article  Google Scholar 

  44. Moore LV, Harris CD, Carlson SA, Kruger J, Fulton JE (2012) Trends in no leisure-time physical activity–United States, 1988–2010. Res Q Exerc Sport. 83(4):587–91

    Article  Google Scholar 

Download references


The study was funded in part by the Roswell Park Cancer Center Support Grant Shared Resource, supported by the National Cancer Institute Grant P30CA016056; Arinden Sen is supported by NIH R21CA194634 (AS).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Rikki A. Cannioto.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The research described herein was approved by Roswell Park’s IRB. Thus, all procedures and analyses performed were in accordance with the ethical standards of Roswell Park and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the DBBR study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 45 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cannioto, R.A., Dighe, S., Mahoney, M.C. et al. Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes Control 30, 1–12 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: